NUTRITIONAL CARE FOR

MALABSORPTION SYNDROMES

NUTRITIONAL CARE FOR MALABSORPTION SYNDROMES

A. LACTOSE-RESTRICTED DIET

B. POSTGASTRECTOMY DIET

C. GLUTEN- FREE DIETS

- Which relieves the uncomfortable symptoms of lactose intolerance.

- Controls malabsorption that may occur following surgery of the stomach

- Reverse malabsorption caused by celiac disease.

LACTOSE-RESTRICTED DIETS

Are highly individualized diets that most often limit, but do not exclude, milk and milk products.

Treat malabsorption caused by a deficiency of lactase, the enzyme that splits lactose to glucose and galactose.

MEDICAL NUTRTION THERAPY FORLACTOSE INTOLERANCE

Clients should test their tolerance for lactose by gradually increasing consumption of lactose-containing foods the point that precipitates symptoms of lactose intolerance- bloating, cramps, and diarrhea.

Include 1 or 2 cups of milk per day, provided that the milk is taken with food and in small at a time

Yogurt contains bacteria that produce lactase and thus help digest lactose.

POSTGASTRECTOMY DIET

- POSTGASTRECTOMY following surgery that removes all (total

gastrectomy) or part (subtotal or partial gastrectomy) of the stomach.

POSTGASTRECTOMY DIET

This diet aims: to provide the energy and nutrients

necessary to support recovery and minimize complications associated with gastric surgery.

One complication that can arise when the portion of the stomach containing the pyloric sphincter has been removed, bypassed, or disrupted is the DUMPING SYNDROME.

DUMPING SYNDROME

Rapid emptying of the stomach contents into the small intestine.

The symptoms that result from the rapid entry of undigested food into the jejunum:

3D’s Diaphoresis Drowsiness Diarrhea

Hypoglycemia (late sign)

DIETARY MANAGEMENT OF DUMPING SYNDROME

Modifications: Rationale:

Chew foods thoroughly and eat slowly.

Avoid concentrated sweets

Because the body digests and absorbs these carbohydrates rapidly and breaks them down into many particles that draw fluids from the body into the intestine.

DIETARY MANAGEMENT OF DUMPING SYNDROME

Modifications: Rationale:

SFF

Drink fluids in small amounts about 45 mins., Before or after meals.

To fit the reduced storage capacity of the stomach. THUS, IT PREVENTS

DUMPING OF FOOD INTO THE INTESTINE

To prevent overloading the stomach’s reduced storage capacity and slows the transit of food from the stomach to the intestine.

DIEATRY MANAGEMENT OF DUMPING SYNDROME

Modifications: Rationale: Dry solid diet

Lie down immediately after eating for 30 to 60 mins.

Be aware that lactose intolerance may develop and add to the problem diarrhea and abdominal pain

Better than liquids as they enter the jejunum less rapidly.

To help to slow transit of food to the intestine. Clients who experience reflux, however, should not lie down after eating.

DIETARY MANAGEMENT OF DUMPING SYNDROME

Modifications: Rationale:

DIET: HIGH FAT

HIGH CHON

LOW CHO

Delays emptying of the stomach

Increase colloidal osmotic pressure and prevent shifting of plasma

No simple sugars

POP QUIZ

Management of dumping syndrome is best accomplished by planning to maintain the patient on a:

A. Low CHON, High CHO

B. Low residue, bland diet

C. Fluid intake of at least 500 ml with each meal

D. Small frequent feeding schedule

GLUTEN – FREE DIETS

GLUTEN A protein found in wheat.

Eliminates certain grains that inflame the intestine and lead to malabsorption for people with CELIAC DISEASE.

CELIAC DISEASE

Also called Celiac sprue/ Gluten-sensitive enteropathy PERMANENT inability to tolerate dietary

gluten in the small intestine.

A sensitivity to a part of the protein gluten that causes flattening of the intestinal villi and malabsorption.

DIETARY MANAGEMENT OF CELIAC DISEASE

Modifications: Rationale:

HIGH Calories HIGH CHON

Gluten free diet

Low Fat

To compensate for weight loss

Gluten is the toxic factor

Impaired fat absorption

TREATMENT FOR CELIAC DISEASE

Lifelong adherence to a gluten free diet.

Serves as the primary treatment for celiac disease.

ELIMINATE B-R-O-W

B BARLEY

R RYE

O OAT

W WHEAT

POP QUIZ

Which of the statement needs further teaching, if made by a parent of a two year old child recently diagnosed with celiac disease?

A. “I don’t have to make any major dietary changes until my child reaches puberty.”

B. “I have to keep my child on a gluten-free diet to prevent episodes of diarrhea.”

C. “I should read the labels on any processed foods I offer to my child.”

D. “I will need to notify my child’s school about the special diet.”

DIETARY MANAGEMENT OF DISEASES OF THE:

GALLBLADDER

PANCREAS

LIVER

GALLBLADDER

LIVER

PRODUCES BILE (CHOLESTEROL, BILE SALTS, BILIRUBIN &

H2O)

BILE DUCT GALLBLADDER

REMAINS UNTIL NEEDED FOR FAT DIGESTION

GALLBLADDER

CHOLELITHIASIS The formation or presence of stones in

the gallbladder or CBD.

CHOLECYSTITIS Is the inflammation of the gallbladder.

PREDISPOSING FACTORS: 5 F’S

FEMALE

FAT (OBESE)

FAIR (CAUCASIAN)

FORTY

FERTILE (MULTIGRAVIDA)

CHOLELITHIASIS WITH CHOLECYSTITIS

DIETARY MANAGEMENT: RATIONALE:

IV fluids and electrolytes – Clear liquid

Low calorie

To rest inflamed gallbladder

To prevent and correct dehydration and electrolyte abnormalities

For obese patients

CHOLELITHIASIS WITH CHOLECYSTITIS

Dietary management: Rationale:

LOW FAT, BLAND To prevent stimulation and contraction of the gallbladder which causes pain.

High fat diet enters into the duodenum

Stimulates the pancreas

To release CHOLECYSTOKININ(a hormone is carried by way of the bloodstream to the

GALLBLADDER)

Forces to contract to release BILE

Needed for the EMULSIFICATION OF FATS

POP QUIZ

Which of the following factors, if noted in patient’s history, would indicate a predisposition for developing cholecystitis?

A. Hypertension

B. Depression

C. Obesity

D. Childlessness

PANCREAS

FUNCTIONS Secretes the enzymes necessary for the

digestion of CHO, CHON and FAT , together with bicarbonate-rich juices that provide the optimal pH necessary to activate these enzymes.

Stores digestive enzymes in an inactive form to protect itself from digestion.

PANCREATITIS

The pancreas becomes inflamed, digestive enzymes are activated within the pancreas, and the enzymes damage the pancreas itself.

The blood picks up some of these enzymes; thus serum amylase and lipase rise and serve as indicators of pancreatitis

CAUSES:

Alchohol abuse Drugs (antihypertensives, diuretics, oral

contraceptives) Biliary Obstruction Autoimmune Intestinal Diseases Unknown

ACUTE PANCREATITIS

Most often develops as a consequence of gallstones or alcoholism

Sudden severe abdominal pain, n/v and diarrhea often accompany acute pancreatitis

CHRONIC PANCREATITIS

When severe pancreatitis or repeated episodes of pancreatitis permanently damage the pancreas, absorption, especially of fat, becomes permanently damage.

DIETARY MANAGEMENT OF PANCREATITIS

Modifications: Rationale:

NPO during acute phase

IVF Therapy

NGT

To prevent stimulation pancreatic stimulations.

To manage fluid deficit

To remove gastrin from the stomach and secretin from the duodenum and help relieve pain and digestion.

DIETARY MANAGEMENT OF PANCREATITIS

Modifications: Rationale:

Alcohol is restricted

Low Fat, bland

SFF

Enzyme replacements

To prevent further damage to the pancreas.

To control steatorrhea and prevent stimulation for bile production.

Avoid distention.

Taken with meals Helps digest and absorb

CHON and fat while minimizing steatorrhea.

POP QUIZ

THE DIET OF THE CLIENT WITH PANCREATITIS SHOULD BE:

A. HIGH FIBER, LOW FAT DIET

B. HIGH CALORIE, HIGH FAT DIET

C. LOW FAT, BLAND DIET

D. HIGH PROTEIN, HIGH FAT DIET

CYSTIC FIBROSIS

A hereditary disorder characterized by the production of thick mucus(exocrine glands) that affects many organs including the pancreas, lungs, liver, heart, gallbladder, and small intestine.

CONSEQUENCES OF CYSTIC FIBROSIS Produce secretions of thick, sticky

mucus Impairs the function of lungs and

pancreas

Nutrition implication: Chronic lung disease Malabsorption Loss of electrolytes in sweat

NUTRITION THERAPY FOR CYSTIC FIBROSIS

Dietary management: Rationale:

High Calories

High CHON

Low Fat

Provide for weight gain.

To compensate for the loss.

Lack of enzyme to digest.

NUTRITION THERAPY FOR CYSTIC FIBROSIS

Dietary management: Rationale

Enzyme Replacements

Liberal use of salt

Increase fluid intake

To provide deficient pancreatic enzymes

Help control steatorrhea

To replace the losses of electrolytes in the sweat

To liquefy thick secretions

LIVER

FUNCTIONS:

Metabolizes carbohydrate, protein, and fat so that energy is available to body cells.

Stores glycogen, most vitamins, and many minerals.

Manufactures cholesterol, which serves as a precursor for steroid hormones.

Packages lipids in lipoproteins for transport throughout the body.

Manufactures bile to aid fat digestion.

Makes nonessential amino acid and keeps amino acid composition in the balance for energy use.

LIVER

Converts amino acid to glucose for energy use.

Converts ammonia from the blood to urea so that it can excreted by the kidneys.

Makes plasma proteins including lipoproteins, clotting and immune system factors, and protein that carry nutrients throughout the body.

Activates many nutrients.

Detoxifies drugs (including alcohol) and other substances that are harmful to the body.

Dismantles worn-out red blood cells and recycles the iron they contain.

HEPATITIS

Any acute inflammation disease of the liver.

TYPES: ACUTE- viral, drug-induced, toxic CHRONIC- active or persistent

It can be caused by viruses, bacteria or toxic injury to the liver.

HEPATITIS

2.) TOXIC HEPATITIS Can be caused by drugs, alcohol,

industrial toxins and plant poisons.

B. CHRONIC

1.) ACTIVE A d/o characterized by continuing hepatic

necrosis, active inflammation and fibrosis which may lead to cirrhosis.

2.) PERSISTENT

Rare extra hepatic involvement, may be secondary to viral hepatitis.

MEDICAL NUTTRITION THERAPY

The person with hepatitis:

Good nutrition status

Malnourished

Anorexia

vomiting

Regular, well-balanced diet

High calorie, high protein

SFF

IV fluids replacement

LIVER CIRRHOSIS

Slow destruction of liver cells and proliferation of fibrous tissues eventually leading to scarring of the liver tissues.

Characterized by:jaundice ascitesCNS dysfunctioncachexiaportal HPN esophageal

varicessplenomegaly

DIETARY MANAGEMENT OF LIVER CIRRHOSIS

Modifications: Rationale:

High CHON

High CHO Low Fat

Low Na Fluid restriction

To regenerate hepatic cells

To prevent hypoproteinemia

To spare CHON To prevent fatty liver

To prevent ascites and edema

DIETARY MANAGEMENT OF LIVER CIRRHOSIS

Modifications: Rationale:

SFF

Full liquid diet

Thiamin supplements

Better tolerance

To prevent irritation of esophageal varices.

To prevent complications: WERNICKE-KORSAKOFF

SYNDROME

POP QUIZ

On admission, a patient is having a symptoms of pancreatitis. Which of the following would have most likely contribute to this diagnosis

A. Increased CHON intake B. Smoking C. Excessive alcohol ingestion D. High cholesterol level